We can wipe out childhood diseases

Orin S. Levine and Myron M. Levine

This month, leaders from around the globe announced a road map for ending preventable child deaths within a generation. Essentially, the ambitious plan aims to assure that every child has the same opportunity for a fifth birthday and a future beyond childhood, thereby ending one of the most obvious social injustices in the world today.

Some will question whether this period of austerity is the time for an ambitious new global health goal. If skepticism had prevailed a half-century ago, it would have derailed one of humanity's great victories: smallpox eradication. Furthermore, it would miss an opportunity to invest in an effort that will generate economic benefits far outweighing its costs.

Then, as now, well-meaning leaders debated whether the goal was even possible. The world was too large, its people too hard to reach and, besides, disease eradication was unprecedented. Thankfully, scientists, health workers, and national and local leaders were determined to overcome these obstacles.

Today, few remember the gruesome sight of a person infected with smallpox — a face obscured behind painful, head-to-toe blisters. For the patient, any movement was agony.

But thanks to investments in vaccines and global health infrastructure, a child born anywhere in the world over the past 35 years will never suffer or even witness this disease. Vaccination strategies last century drove smallpox, gradually, from North America, Europe and South America, and — finally — from Africa and Asia. A disease that had blinded, disfigured and killed adults and children since the time of the pharaohs was no more.

In 2012, we have issues to face that are no less challenging, but the prospects for their success are brighter than ever. For example, more recent additions to the vaccine list — such as protections against diarrhea and pneumonia, the world's two leading killers of children — have inspired new partnerships and exciting mechanisms for the financing, development, production, delivery and tracking of vaccines.

What's more, now, as never before, we have a compelling economic case to accompany the moral one. Analyses by the International Vaccine Access Center (IVAC) at the Johns Hopkins Bloomberg School of Public Health show that by scaling up the coverage of existing vaccines for diarrhea and pneumonia in the world's poorest countries, we would not only save the lives of 3.7 million children and prevent more than 100 million cases of illness, but vaccination in the next decade would also prevent the loss of $63 billion in treatment costs and lost productivity. Based on IVAC's analysis of the five countries where most lives would be saved, the economic value of vaccination programs is somewhere between three and 18 times the projected costs of purchasing the vaccines — an amazing return on investment.

Eradicating smallpox taught us new ways to gather disease data, empower local leaders, create incentive programs, set up delivery chains and drive innovation. But the most important lesson was not to fear big, ambitious global health goals. When many people believed there were only enough resources to treat the symptoms of smallpox, enough people disagreed and set out to defeat it. Those investments turned out to be profoundly wise and provided significant returns, and we all are living proof.

Today, as then, government and private sector leaders will face difficult choices about how to invest their limited funds. The case for investing in vaccines and child survival should not be one of the difficult ones, and they should not back away from the audacious goal of ending preventable child deaths.

As Secretary of State Hillary Clinton said at this month's summit, "If we meet the goal we are committing to, we will have added another story to the short list of the greatest things people have ever done for one another. And we will have set ourselves on a path to a world that is more stable, more prosperous and more just."

Orin S. Levine (olevine@jhsph.edu), a professor and executive director of the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health, has worked to accelerate global access to pneumonia vaccines for nearly two decades. Myron M. Levine (mlevine@medicine.umaryland.edu), the Grollman Distinguished Professor and director of the Center for Vaccine Development at the University of Maryland School of Medicine, participated in the Smallpox Eradication Program in rural Bangladesh.